Two types of radiotherapy for gallbladder cancer

Radiotherapy is a common and effective method for the treatment of gallbladder cancer. There are two main forms, namely, intraoperative internal irradiation and postoperative external irradiation. The former is mainly suitable for patients undergoing palliative surgery, using electron beams generated by a cyclotron to irradiate the liver resection margin, liver, and duodenal ligaments that may have residual cancer lesions; the latter is suitable for patients who have undergone radical or palliative resection of gallbladder cancer and those who cannot be removed surgically.

1. Intraoperative internal irradiation

Palliative gallbladder cancer surgery is generally combined with intraoperative internal irradiation, especially for the treatment of Nevein stage V. The electron beam generated by the cyclotron is used to irradiate the liver resection margin, the liver, and the possible remaining cancer lesions in the duodenal ligament. The intraoperative irradiation dose is 20 to 30 Gy. Radiotherapy can alleviate the jaundice and pain symptoms of gallbladder cancer patients to a certain extent.

2. Postoperative external irradiation

Postoperative external radiotherapy is suitable for patients who have undergone radical or palliative resection of gallbladder cancer and cannot be removed surgically. The total amount is 30 to 50 Gy, which is carried out for 3 to 4 weeks. The irradiation range is the primary tumor site and the vicinity of the liver hilum. Todoroki reported that for patients with advanced gallbladder cancer, the 3-year cumulative survival rate of patients who underwent cholecystectomy plus radiotherapy was about 10%. If the patient's condition is severe or does not meet the indications for surgical resection, appropriate doses of radiotherapy can be given according to the patient's condition. Generally, high-dose radiotherapy is advocated, with a dosage of 70 Gy, which should be completed within 7 to 8 weeks. This approach may prolong the patient's survival. If jaundice deepens during irradiation, or sexual pain persists, or the lesion is more advanced than before on B-ultrasound examination, it is generally believed that radiotherapy is ineffective and irradiation should be terminated immediately.